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[News] Guidelines for the allocation of critical resources
#1
Angry 
Guidelines for the allocation of critical resources
A MODEL HOSPITAL POLICY FOR ALLOCATING SCARCE CRITICAL CARE RESOURCES: AVAILABLE ONLINE NOW


HOMA MODEL HOSPITAL POLICY FOR ALLOCATING SCARCE CRITICAL CARE RESOURCES: AVAILABLE ONLINE NOW


[Image: PPE%20final%20web.png]
 
A Model Hospital Policy for Allocating Scarce Critical Care Resources
 
To assist hospitals and health systems to implement a fair and transparent approach to allocating scarce critical care resources during the COVID-19 pandemic, we have created a model hospital policy that hospitals can download and adapt for their needs. Click here for a PDF version and here for an editable MS Word version.
In March 2020, in response to the intensifying COVID-19 pandemic, Dr. Douglas White consolidated a decade-long research and community engagement effort into a model hospital policy that is designed to be practical and clear for clinicians. Dr. White and Dr. Halpern (from the University of Pennsylvania) are undertaking extensive efforts to disseminate the policy nationally and internationally.


What are the important features of the model hospital policy?
1. A major strength of the allocation framework described in the policy is that it does not exclude large groups of community members and patients from access to critical care, which many other allocation strategies do.
2. It allows priority to go to those patients most likely to benefit.
3. The framework is grounded in widely-endorsed ethical principles and has been vetted with ethicists and community members.
4. The model policy was intentionally designed to be feasible to deploy in the chaotic and time-pressured circumstances of a pandemic or disaster.

How did we develop the model policy?
The model hospital policy arose out a decade-long effort involving ethicists, diverse community members' and patients’ groups, and disaster medicine experts. This process began in 2009 when Dr. White and colleagues published the original allocation framework in the Annals of Internal Medicine.
Thereafter followed a three-year project of engaging diverse community members and patients regarding their views on how to allocate scarce resources in a pandemic. This project was led by Lee Daugherty-Biddison and Eric Toner at the UPMC Center for Health Security (now called the John Hopkins Center for Health Security). The community engagement efforts yielded broad endorsement of the general features of the allocation framework, as well as important suggestions for modifications (published in Annals of the American Thoracic Society and CHEST), which where were incorporated into subsequent revisions.

Media interview requests and recent news:
For news media interviews or other media inquiries, please contact Arvind Suresh at suresha2@upmc.edu or 412-509-8207.
On March 23rd, 2020, the allocation framework summarized in the model policy was endorsed by the commonwealth of Pennsylvania as the recommended allocation framework for all Pennsylvania hospitals.
On March 23rd, 2020, two articles were published in NEJM that support the key principles in the allocation framework.
As of March 24th, 2020, this model policy has been adopted or is being considered for adoption by several hundred hospitals across the United States.


About Dr. Douglas White, MD, MAS
Dr. White is the UPMC Endowed Chair for Ethics in Critical Care Medicine and professor of Critical Care Medicine, Medicine, and Clinical and Translational Science in the Department of Critical Care Medicine at the University of Pittsburgh. Professor White is director of the CRISMA Program on Ethics and Decision Making in Critical Illness. He and his colleagues conduct scholarly work to understand and improve how medical decision are made for critically ill patients, many of whom are unable to made decisions for themselves.
Further information:  Dr. White and Dr. Halpern encourage the leaders of all US health systems to download the model hospital policy to aid their planning for allocating scarce resources across their hospital or health system. They are available for consultation on the policy by sending an email to douglas.white@pitt.edu or shalpern@upenn.edu.
References
White DB, Katz MH, Luce JM, Lo B. Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med 2009;150:132-8.
Daugherty Biddison EL, Gwon H, Schoch-Spana M, Cavalier R, White DB, Dawson T, Terry PB, London AJ, Regenberg A, Faden R,  Toner ES. The community speaks: understanding ethical values in allocation of scarce lifesaving resources during disasters. Annals of the American Thoracic Society 2014;11:777-83.
Daugherty Biddison EL, Gwon HS, Schoch-Spana M, Regenberg AC, Juliano C, Faden RR, Toner ES. Scarce Resource Allocation During Disasters: A Mixed-Method Community Engagement Study. Chest 2018;153:187-95.
Daugherty Biddison EL, Faden R, Gwon HS, Mareiniss, DP, Regenberg, AC, Schoch-Spana, M, Schwartz, J, Toner, ES. Too Many Patients...A Framework to Guide Statewide Allocation of Scarce Mechanical Ventilation During Disasters. Chest 2019;155:848-54.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#2
Guidelines for the allocation of critical resources
My reading is that you won't be fortunate enough to receive euthanasia, but will get "palliative care" .  That's a cold calculus and doesn't look good for older individuals or those with chronic health problems. It takes into account the likelihood of survival, and how many years that survival may return.  Wow.  UPMC (Pittsburgh).  An essay on how to detach yourself from emotion and humanity.
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#3
Guidelines for the allocation of critical resources
That's nice to know. I'm probably in the moderate to low valued group in getting medical care because of my COPD and 41-60 age group. Feel the love.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Guidelines for the allocation of critical resources
I don’t know about you guys, but I chose the “editable“ MS Word version.

Not sure if they will accept my edits, but it’s worth a try.

John
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#5
RE: Guidelines for the allocation of critical resources
I have edited the title of this thread as the original title was highly misleading.

It's important to read the full document (~10 pages) which sets out in some detail how hospitals should go about allocating scarce resources (ie ventilators) in the event of a major epidemic. It also advises that patients on ventilation should be assessed as to their prognosis - a patient who is likely to die anyway might be denying treatment to somebody with a better chance of survival. In the event that a patient on a ventilator has a poor prognosis and is denying the machine to others, then ventlation should be withdrawn and the patient given palliative care.

An 8-step scale of ranking patients is proposed, based on factors such as initial prognosis, comorbidities and so on. In the event of patients being equally ranked, priority should be given to the younger patient. On this basis I wouldn't expect to get a ventilator - I'm 68, retired, average general health with diabetes. It sucks, but it's something I believe we have to accept.

Yes, this is a very cold view and detached from "humanity" but I think that's the very purpose of the document. Triage teams are detached from the treating clinicians so that a rational approach can be adopted rather than an emotional approach. This is important for the health of the whole population, but also reduces the emotional stress on clinicians who are faced with these unbearable decisions.
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#6
RE: Guidelines for the allocation of critical resources
There probably exists a confidential memo that explains that the wealthy, powerful, and political people are deemed essential to our nation and go to the head of the line -- that is if they don't already have their own Gucci- or Hermes- adapted ventilator on hand.

And, if you want to see distancing done right, consider billionaire and the major contributor to the UCLA School of Medicine who apparently has distanced himself 3,878 miles from his home in Malibu where he is in self-isolation aboard his 400-foot yacht in the Grenadine Islands.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#7
RE: Guidelines for the allocation of critical resources
Think I'll pas on reading that after reading your comments! I'm 79 with controlled congestive heart failure--thankfully caught very early. I'm staying home for the duration.....
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